Medication: Lomustine

Your dog has been prescribed lomustine for the management of a range of cancers including lymphoma, mast cell tumors and histiocytic sarcoma.

Key points: 
• Antineoplastic chemotherapy drug.
• Alkylating agent which kills certain types of cancer cells.
• Do not handle lomustine if you are pregnant, breastfeeding, under 18, immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Aways wear gloves to handle the capsules and wash your hands afterwards.
• Never open or split capsules.
• Dogs will excrete chemotherapy products up to 7 days after administration so precautions must be followed to reduce exposure to other people and pets.
• Dosage: every 3-4 weeks. 

This information sheet is designed to help answer commonly asked questions and help you give the medication safely and effectively to your pet. It does not contain all available information for this medication. If you have other questions or need more information, contact your veterinarian or pharmacist. Always follow the dosing instructions provided by your veterinarian.

Name

• Lomustine (lom-us-tine).

Brand name

• There are no licensed veterinary products containing this drug. Your veterinarian may prescribe a human medication containing this drug.   
• CeeNU ®.
• Gleostine®.

Class of drug

• Antineoplastic chemotherapy drug.
• Alkylating agent.

Storage

• Stable if stored in well closed containers at room temperature until expiration date indicated on package.
• Avoid excessive heat over 40°C.

Your veterinarian has prescribed lomustine either as a single agent or as part of combination therapy for the management of a range of cancers including lymphoma, mast cell tumors and histiocytic sarcoma.

Lomustine is given as oral capsules that are available in a variety of sizes. The capsules must never be opened but can be given whole in food.

Handling lomustine

• Do not handle lomustine if you are pregnant, breastfeeding, under 18, immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Aways wear gloves to handle the capsules and wash your hands afterwards.
• Never crush or split capsules as it can result in dust which could be dangerous to those around.
• Keep your dog’s drugs in the container supplied. This should be a child proof container.
• Store them in a safe place and always out of the reach of children and pets.
• Lomustine capsules can be safely given in a little bit of food but make sure it’s not left behind in the bowl or on the floor! It is also fine to give the capsules directly – they can be washed down with some food or water by syringe afterwards to prevent them getting stuck.
• If you find a capsule on the floor after giving the medication, wear gloves to pick it up and bag it. Do not give another dose until you have spoken to your veterinarian.
• If you are unable to give tablet medication to your dog, please contact your veterinarian for advice.

The following side-effects reactions have been noted:

• Gastrointestinal symptoms (rare): not eating, nausea, vomiting, diarrhea.
• Low white cell count (leukopenia or neutropenia) – regular blood tests will monitor the white blood cell counts.
• Low platelet counts (thrombocytopenia) (uncommon).
• Low red cell counts (anemia) (rare).
• Increased liver parameters on blood tests – if severe this may mean that your pet has to stop lomustine or get it less frequently. If the changes are mild then your veterinarian may prescribe liver protectants. In some cases liver protectants will be given as a routine during treatment.

Some drugs may interact with lomustine. If your dog is taking other medications or supplements, please check these with your veterinarian before starting treatment.

Lomustine is usually given every 3-4 weeks as part of chemotherapy treatment.

All unused drugs should be returned to your veterinary practice for disposal and must not be placed in household waste.

If you miss a dose, give the dose as soon as possible but do not double up a dose. Make sure the dose given does not exceed the total recommended amount in any 24-hour period.

Contact your veterinarian immediately if you have given your dog an overdose of lomustine. It can be highly toxic if an overdose is administered.

Do not administer lomustine if your pet is unwell – contact your veterinarian for advice.

You must also contact your veterinarian straight away if:

• Your pet has a high temperature (above 38.8ºC/102ºF – with a fever they will usually be quiet and unwilling to eat).
• Your pet is unwell (even without a high temperature).
• Your pet has vomited or has diarrhea.

Lomustine should only be given to the dog that it has been prescribed for.

Keep out of reach of children – if accidentally eaten, speak to your primary care physician or poison control center.

Handling your dog

• Your dog will excrete products from the chemotherapy drug for up to 7 days after lomustine has been given. This period is referred to as the “chemo barrier” period. As there is a small risk of you absorbing these toxic products, there are some sensible precautions that you should take to reduce your exposure during this time.
• Wear gloves when handling any urine, feces, vomit or saliva from your dog.
• Aways wash your hands after handling your dog and before eating or drinking.
• The following people should minimize direct contact with your dog:
  • Pregnant or breastfeeding women
  • Young children who do not understand the need for hand washing after contact
  • Immunosuppressed or receiving chemotherapy or immunosuppressive drugs.
• Dogs should be exercised away from areas where children play or where there are lots of other dogs. However they are fine to remain in contact with other pets in the home.
• Double bag all feces and dispose of them as normal. We do not recommend flushing them down the toilet due to risk of aerosols forming.
• Urine passed on a surface where it can drain away (such as grass or soil) is not a problem. If your dog passes urine on a solid surface (pavements, paths etc) use a bottle of water to rinse away the urine.
• There is no risk to other pets in the home from sharing water bowls or toileting in the garden unless the other pet is likely to ingest any contaminated urine or feces. In any case feces passed in the garden should be double bagged as soon as they have been passed.
• If your dog should have an accident in the house or soil itself, you should wear gloves to clean the area as quickly as possible using copious amounts of soapy water. Use disposable paper towels to dry the area and dispose of these in a plastic bag in an outside bin.
• Your dog’s bedding should be washed regularly as some toxic products may end up on your dog’s coat when they lick themselves.
• We discourage people from allowing their dog to sleep in the family beds because their coat may be contaminated.

Your pet will require blood tests to be checked prior to each dose. Your veterinarian will want to monitor your pet to make sure that treatment is working.

Further information

If you have any concerns, further information on lomustine can be found on the package insert.

 Europe & UK

• There are no licensed veterinary products containing this drug in the UK or Europe. Your veterinarian may prescribe a human medication containing this drug and will explain off-license use of medications to you.

US

• There are no licensed veterinary products containing this drug in the US. Your veterinarian may prescribe a human medication containing this drug and will explain off-license use of medications to you.

Always follow the recommended dosage and contact your veterinary team or pharmacist if you have any questions regarding your dog’s medication.